title: Ehrlichiosis presenting with toxic shock-like syndrome and secondary hemophagocytic lymphohistiocytosis.
abstract: Human monocytotropic ehrlichios is a tick borne illness caused by Ehrlichia chaffeensis. Ehrlichiosis presenting with septic shock and severe azotemia is rare, and may be seen in immunocompromised individuals. We present a case of ehrlichia induced toxic shock like syndrome in a patient with rheumatoid arthritis on disease modifying agents. He also had oliguric renal failure requiring dialysis on presentation and later found to have Hemophagocytic Lymphohistiocytosis secondary to severe ehrlichia sepsis.
authors.affiliation: Department of Internal Medicine, University of Arkansas for Medical Sciences Little Rock, AR, USA.
authors.forename: Richa
authors.initials: R
authors.lastname: Pandey
authors.forename: Rajan
authors.initials: R
authors.lastname: Kochar
authors.forename: Susan
authors.initials: S
authors.lastname: Kemp
authors.forename: Dumitru
authors.initials: D
authors.lastname: Rotaru
authors.forename: Sudhir V
authors.initials: SV
authors.lastname: Shah
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D000368:Aged; D018469:Ehrlichia chaffeensis / Q000302:isolation & purification*; D016873:Ehrlichiosis / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D008264:Macrophages / Q000382:microbiology; D008297:Male; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000382:microbiology